GP Buzz December 2012 - February 2013
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share

GP Buzz December 2012 - February 2013

  • 58,087 views
Uploaded on

In this edition, you will find health ...

In this edition, you will find health
essentials for all men, starting from
the cover story on colorectal cancer,
the most common cancer in men.
A feature on the latest advances,
techniques and drugs for
cardiovascular diseases, the second
top killer of men is also included.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
58,087
On Slideshare
3,935
From Embeds
54,152
Number of Embeds
17

Actions

Shares
Downloads
30
Comments
0
Likes
0

Embeds 54,152

http://www.ttsh.com.sg 50,032
http://ttsh.com.sg 3,877
http://ttshwebcms 202
http://106.10.137.112 13
http://webcache.googleusercontent.com 11
http://cc.bingj.com 4
http://translate.googleusercontent.com 2
http://74.6.116.71 2
http://honyaku.yahoofs.jp 1
http://www.ttsh.com.sg&_=1360718050271 HTTP 1
http://www.ttsh.com.sg&_=1357618796189 HTTP 1
http://www.ttsh.com.sg&_=1357545831309 HTTP 1
http://www.ttsh.com.sg&_=1357110597283 HTTP 1
http://www.ttsh.com.sg&_=1356591493543 HTTP 1
http://www.ttsh.com.sg&_=1356058606771 HTTP 1
http://www.ttsh.com.sg&_=1355993640480 HTTP 1
http://was.nl.sg 1

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. A PUBLICATION FOR PRIMARY CARE PHYSICIANS MICA (P) 242/03/2012 DECEMBER 2012-FEBRUARY 2013UnblockingYourSleepGet TacklingRight Sports InjuriestotheHeart How to Satisfy Your Partner Sculpt Your Scan the QR code using your iPhone or smart phone Core to view GP BUZZ on the TTSH website or visit http://www.ttsh.com.sg/gp/.
  • 2. contents editor’s note 15 Man Your Health in every issue At 64 years of age, Mr Ang stands at a height of 1.65 metres and weighs over 80kg. His BMI shows that he’s obese. With 030 editor’s note high total blood cholesterol, Mr Ang has to be on medication to control his cholesterol level and he routinely visits the local 040 in the news hospital every six months for a blood cholesterol test. The GP BUZZ editorial team: Jessie Tay M Lee Wei Kit 260 fitness Celine Ong r Ang is just one In this edition, you will find health 310 healthy recipes example of one in essentials for all men, starting from ADVISORY PANEL: eight Singaporean the cover story on colorectal cancer, Associate Professor Thomas Lew Associate Professor Chia Sing Joo men* with a BMI of the most common cancer in men. Associate Professor Chin Jing Jih more than or equal A feature on the latest advances, to 30kg/m2 or categorised as obese. techniques and drugs for 22 Dr Chong Yew Lam Dr Tan Kok Leong Joe Hau in this issue This places him in the high risk group cardiovascular diseases, the second of developing heart disease and top killer of men is also included. diabetes. High total blood 06 an, Watch Your Colon! M GP Buzz is a quarterly magazine by cholesterol also affects over 18% of Together with other spotlights on Tan Tock Seng Hospital, designed by the local male population. In fact, common men’s health conditions like 11 Get Right to the Heart the results of the 2010 National sleep apnoea, tips on satisfying your 15 Unblocking Your Sleep Health Survey by Health Promotion partner sexually, ways to stayWe value your feedback on how we can enhance the content of GP Buzz. Please send in your Board have shown that there are injury-free in sports; this Men’s comments and queries to gp@ttsh.com.sg. 18 How to Satisfy more men with major non- Health issue of GP BUZZ promises to © All rights reserved. Your Partner communicable diseases and health be a power-packed edition. No part of this publication may be reproduced risk factors (e.g. diabetes, or transmitted in any form by any means without prior consent from the publisher. 22 Tackling Sports Injuries hypertension, obesity, cigarette That’s not all. We bring you core smoking, alcohol drinking) than exercises for body-sculpting and women. strength-building in the fitness section. To boot, we have a protein As primary healthcare practitioners, packed steak dish specially you are placed in a unique position developed by TTSH’s Food & to care and lead these male patients Beverage and Nutrition & Dietetics to better health. Hence, we have Departments. 26 18 developed a Men’s Health edition of GP BUZZ, following Women’s Health Have an enriching read! in the last issue. The GP Buzz Editorial Team Raising the red alert is easy but without knowledge and steps to improve on health, all efforts will come to nought. * Singapore residents and permanent residents aged 18 to 69 years of age. DECEMBER 2012-FEBRUARY 2013 03
  • 3. in the news in the news Clinicians T he National Medical Excellence Award (NMEA) 2012 Honoured at initiated by the Ministry of Health, honours the best talents in Singapore’s medicine. It recognises the National the exceptional contributions of distinguished individuals and teams not only in medicine and also in clinical research, clinical quality, education, training and Medical mentorship. Excellence This year, two clinicians from Tan Tock Seng Hospital (TTSH) were honoured amongst the 10 medical Award (NMEA) professionals who received their awards from Mr Gan Kim Yong, Minister for Health and Guest-of-Honour at 2012 the ceremony held on 28 August 2012 at the Hilton Hotel, Singapore. New One-stop Multidisciplinary Facility for Musculoskeletal Conditions T an Tock Seng Hospital officially launched a infusions including biologics for inflammatory arthritis. multidisciplinary centre for treatment of A pharmacy is also housed within the facility for seamless musculoskeletal conditions on 17 September and holistic patient care. 2012, laying the foundation for a musculoskeletal centre of excellence for patient-centric care, training, The Musculoskeletal Centre will eventually integrate education and research. with the existing Pain Management and Sports Medicine and Surgery services, as well as Allied Health services Occupying more than 3,000 square metres of floor area, which include Occupational Therapy and Physiotherapy. this new facility within the Medical Centre Block comprises 56 consultation and treatment rooms; diagnostic imaging rooms including on-site bone mineralAdjunct Associate Professor Associate Professor Lim Tock Han, densitometry, musculoskeletal ultrasound and nailfoldTai Hwei Yee, Deputy Chief Quality Officer, Assistant CEO (Education & Research) of NHG and capillaroscopy services; a hand procedure suite, a dayNHG and Senior Consultant, Department of Senior Consultant, Department of Ophthalmology of facility and pharmacy. Our specialists in Orthopaedic andAnaesthesiology, Intensive Care & Pain Medicine of TTSH, was awarded the National Outstanding Clinician Hand Surgery, Rheumatology, Allergy and ImmunologyTTSH, was awarded the National Outstanding Clinical Educator Award 2012. (RAI) now share this new facility, giving our patientsQuality Activist Award 2012. better access to interdisciplinary management of various A/Prof Lim’s passion and his immense contributions musculoskeletal conditions.Adj. A/Prof Tai was recognised for her contributions in towards the creation of an encouraging learningadvancing clinical quality and patient safety in environment for clinicians as well as his continuous Patients now move seamlessly among imaging,Singapore and in introducing innovative clinical quality efforts in nurturing the current generation of clinicians consultation, procedure and treatment areas. A Handimprovement programmes that have led to an increased were acknowledged through this award. Procedure Suite offers same day local anaestheticquality, sustained safety and standards in patient care. procedures. Occupational therapists and podiatrists Working as a team: (Second from left) provide joint consultation with our hand and ankle/foot Adj. Asst. Prof Ganesan Naidu Rajamoney, Orthopaedic Surgery, Head of surgeons respectively. A dedicated 8-hour day facility is Department, Consultant and Dr Bernard Thong, Rheumatology, Clinical Immunology & Allergy, Head of Department, Senior Consultant with members available for patients who require outpatient intravenous of their team.04 05
  • 4. cover story cover story Man, C olorectal Cancer is the cancer with the a total colonic examination can be done using highest incidence in Singapore. The colonoscopy or a double contrast enema once incidence of Colorectal Cancer in every five to ten years. Singapore for both females and males has watch steadily increased over the past 20 years. The 2. Moderate Risk average lifetime risk of a Singaporean is 1:55. Those at moderate risk include asymptomatic This risk increases with age and rises sharply individuals with a first degree relative from the age of 50 years onwards. diagnosed with Colorectal Cancer who is less than 45 years old; or two first or second degree your In men, Colorectal Cancer was the most relatives from the same side of the family with common cancer with 4,456 cases from 2006 to Colorectal Cancer diagnosed at any age. 2010. This condition affects one in every 20 men as compared to one in every 30 women.* It is recommended that they should have a colonoscopy at a three-yearly interval from age Therefore, in an effort to increase survival colon! 45 or 10 years younger than the age of the rates, population screening programmes such earliest diagnosis of colorectal cancer in the as the National Colorectal Cancer Screening family. Programme organised by Health Promotion Board for early diagnosis and treatment have been developed. 3. High Risk High-risk individuals are those with a hereditary or genetic predisposition, such as Colorectal Cancer is most prevalent Colorectal familial adenomatous polypsis. These people in men. Regular screening for this Cancer Screening should be screened yearly after diagnosis. Our local Colorectal Cancer screening disease allows for early diagnosis guidelines divide the population into three After identification of Colorectal Cancer, a thorough evaluation is required to rule out and effective treatment. categories based on the risk of the Cancer: synchronous cancers and significant polyps. average, moderate and high risk. An assessment to rule out advanced or Colorectal Cancer patients need not 1. Average Risk metastatic disease is also needed. fret as an individualised treatment Screening for average risk individuals should For colon cancers, a CT scan of the abdomen process and a multidisciplinary begin at 50 years old. This includes an annual and pelvis together with a chest X-ray is usually digital rectal examination, either a yearly fecal team are at hand to help men (and occult blood testing and a flexible done. For rectal cancer, besides the above, endorectal ultrasound or MRI pelvis is done to women) combat this condition. sigmoidoscopy every five years. Alternatively, assess the depth of tumor penetrations through * Singapore Cancer Registry Interim Report, 2006 to 2010, Ministry of Health.06 07
  • 5. cover story cover story the rectal wall and for assessment of the locoregional lymph nodes. Carcinoembryonic • Minimally Invasive Surgery decrease the risk of recurrence and optimise oncological outcomes. In men, Colorectal Cancer There is an increasing trend towards Antigen (CEA) is routinely used for advanced and metastatic diseases and may be a predictor minimally invasive surgery, such as Standard Surgical options in rectal carcinoma also vary was the most common for poor outcome. Laparoscopic or Single Incision Laparoscopic (SIL) colectomies. Studies have shown many depending on the type and location of the cancer with 4,456 cases post-operative benefits such as a reduction in post-operative pain, a reduced incidence primary tumour. Options of transanal excision (for low tumour) and transanal from 2006 to 2010. Surgical Therapy – of post-operative ileus and decreased length endoscopic mircosurgery (for higher tumour) The Main Treatment of hospitalisation stay. In experienced are available for carcinoma in situ and T1N0 Our specialised colorectal nurses will also rectal carcinoma, although studies have give regular telephone consultations with For colorectal cancer, surgery is the mainstay hands, all oncological principles are shown higher recurrence rate even with our post-operation patients to ensure their of curative treatment. maintained. clear margins. well-being. The goal of surgical therapy is to do a complete The operation time is also comparable to Radical surgery for rectal cancer should be As an increasing number of people are resection of the primary lesion, all the primary open surgery and with meticulous specimen performed for larger tumours. Sphincter diagnosed with Colorectal Carcinoma, feeding vessels, the adjacent organs if local handling and extraction techniques, port preserving low anterior resection can be a specialised team of specialists should be invasion is present and the regional lymph nodes. site metastasis are not more common than performed safely when cancers are located dedicated in looking after them to ensure incisional metastasis in open colonic more than one centimetre from the upper the best outcome possible. surgeries. portion of the anorectal ring. Otherwise, In Tan Tock Seng Hospital (TTSH), an an abdominoperinal resection is preferred. Therefore, to stem the spread of increasing number of patients have this condition, do encourage your undergone minimally invasive surgery with Post-operative chemotherapy for colorectal patients, especially male patients, positive results. carcinoma is usually recommended to to undergo the screening tests improve survival rates for tumours which regularly. are stage two and above. • Individualised Treatment for Each Patient Men out there, remember to watch • Multidisciplinary Team your colon! For rectal carcinoma, deciding on the Management optimal treatment plan is a complex and a In TTSH, our patients diagnosed with highly individualised process. Colorectal Carcinoma are seen by a Dr Tay Guan Sze multidisciplinary team consisting of surgeons Dr Tay Guan Sze is the Head and Consultant of the Colorectal Stage one rectal cancer can be treated (colorectal surgeons, hepatobiliary surgeons, Surgery Unit, General Surgery Department in Tan Tock Seng definitely with surgery alone. However, Hospital. He completed his fellowship training in surgery thoracic surgeons), a medical oncologist, a for inflammatory bowel disease and recurrent rectal tumour patients with stage two and three cancers radio oncologist and a radiologist. They are in Leeds General Infirmary, UK. His specialty interests are are treated with neoadjuvant chemotherapy in complex colorectal tumour including recurrent rectal also assessed by a dietitian, a stoma nurse Dr Tay Guan Sze explaining the colonoscopy process to a patient. and radiotherapy prior to surgery to tumour. and a physiotherapist.08 09
  • 6. cover story featureA Patients JourneyEarly DetectionSaved His Life! At 57 years of age, Mr Boo Ai Kuan enjoys an or pains apart from the hematochezia that easy and comfortable life. With two adult Mr Boo experienced. children and a grandchild, he is a face of bliss and contentment. Nobody would have guessed The subsequent treatments were administered that he was once a stage three Colorectal swiftly, starting with a surgery to remove the Cancer patient two years ago. cancerous lump in Tan Tock Seng Hospital in December 2010 by Dr Tay. Mr Boo recovered A carpenter by profession, Mr Boo loves quickly from the surgery without much pain. indulging on food, especially meaty delights. With nary any exercise apart from physical The subsequent chemotheraphy sessions in Johns activities at work, Mr Boo’s health spiralled Hopkins Singapore International Medical Centre Get downhill. (JHSIMC) however proved to be physically draining for Mr Boo. Fortunately, Mr Boo’s body In 2010, Mr Boo found blood in his stool reacted well to the treatment and he was given (hematochezia) and he went on to seek help a clean bill of health eight months later. from his General Practitioner who found piles Right developing in his rectum. Medication was Now, Mr Boo visits JHSIMC and Dr Tay annually prescribed and Mr Boo’s condition improved, for his health reviews. He still indulges in food but his hematochezia came back soon after. but goes for healthier dishes with more greens, less oil and salt. Mr Boo was then referred to Ang Mo Kio As the second top killer after to the Community Hospital for detailed checks into his Looking back on his experience two years ago, condition where Dr Tay Guan Sze, Consultant he constantly shares the importance of early cancer in Singapore, ischaemic heart from the Department of General Surgery in detection especially for higher risk groups. Tan Tock Seng Hospital, was also practising in. In fact, as soon as he was diagnosed with diseases are not to be taken lightly As Mr Boo’s specialist, Dr Tay performed a cancer, he urged all the members of his and must be treated immediately. colonoscopy on Mr Boo and found a 1.5 cm lump immediate family to undergo colonoscopy since Heart in his colon which was confirmed to be his family belongs to the moderate risk group With medical advancements, there are malignant. The colorectal cancer was in its and also because Mr Boo knew how it had saved now new ways of treating these diseases third stage but there were no obvious symptoms his own life. for better outcomes and faster recovery for the patient.10 11
  • 7. feature featureC ardiovascular Diseases used to define any group of clinical delayed healing, local inflammation stops cells from reproducing by f) Potential pediatric role because including coronary heart symptoms compatible with acute and impaired endothelial function decreasing blood supply to the they allow vessel growth and do diseases, cerebrovascular myocardial ischemia. resulting in prolonged dual anti- cells. not need eventual surgicaldiseases (stroke), hypertension, platelet therapy. removal.heart failure claimed an estimated 1. New Approach All components of the17.1 million lives globally, making it Radial Artery The main advantages include: bioabsorbable stents except for c) Dual Therapy Stentsthe leading cause of death. In The traditional arterial access to two radio-opaque markers are Stents that leverage a partitionedSingapore, ischaemic heart disease angiogram and percutaneous • Homogenous drug transfer to the expected to be fully absorbed effect, combining an abluminalwas the second killer at 18.7% after coronary intervention or angioplasty entire vessel wall. into the human body within two (facing the vessel wall) sirolimus drugcancer (28.5%) in 20101. The was via the femoral arteries. There to three years. elution for the control of neointimal • Absence of polymer couldincidence of Acute Myocardial is an increasing trend in switching to proliferation and prevent restenosis; decrease chronic inflammationInfarction (AMI) or what is commonly the radial artery as the preferred The main advantages include: and an endothelial progenitor cell and the trigger for lateknown as heart attacks in men is access route due to the following (EPC) capture technology that thrombosis.about twice that amongst women in advantages: a) Reduced or abolished late promotes the accelerated natural20092. • Absence of a stent allows the stent thrombosis due to the healing of the vessel wall after • Improved patient safety and artery’s original anatomy to ‘disappearance’ of the stent. stenting for the prevention ofThese statistics are consistent with comfort, early ambulation, remain intact, notably in cases of thrombosis. b) Improved lesion imaging withthe local health perspective where reduced length of stay, cost and bifurcation or small vessels, computed tomography orthere are more men vis-à-vis women need to stop anti-coagulation thereby diminishing abnormal The main aim and advantage of magnetic resonance.afflicted with high total blood before the angiogram. flow patterns. this technique is to achieve goodcholesterol, hypertension or c) Facilitation of repeat clinical outcomes, promote healing • With the lower complication • With local drug delivery,overweight, all risk factors of treatments (surgical or and reduce dependence on long-term rates, it means better patient overdependence on anti-plateletcoronary heart disease and percutaneous) to the same dual anti-platelet therapy. outcomes and faster recovery. therapy could be curtailed whichcerebrovascular disease. site. means a shorter duration of Currently, Tan Tock Seng Hospital therapy and thereby lowering d) Restoration of natural 3. New DrugsWith enhancements medically and uses the radial artery approach in bleeding risk. vasomotion of the artery. New Anti-platelet Drugstechnologically, we now see more about 80% of all cases. Prasugrel (Effient®) and Ticagrelortreatment options for e) Freedom from side-branch (BRILINTA®) are the two newly This technique is mainly used incardiovascular diseases which allow obstruction by struts and from launched anti-platelets. Both are 2. New Technology treating in-stent restenosis, small strut fracture-inducedfor better healing and improved a) Drug Eluting Balloons vessel disease and bifurcating direct-acting P2Y12 receptor antagonistquality of life for both males and restenosis. similar to Clopidogrel (Plavix®). The drug (Paclitaxel) is mounted on lesions.females. a balloon and delivered to the vessel wall directly. b) Bioabsorbable Coronary StentsThis article provides a lowdown ofthe new techniques and medications This technique is developed to The stent platform is made of bioabsorbable Poly-Llactic Acid In Singapore, ischaemic heartavailable in the treatment of AcuteMyocardial Infarction (AMI) or Acute overcome the problems with drug (PLLA) and has a polymer coating disease was the second killer at eluting stents of late and very late that contains and controls theCoronary Syndrome (ACS), terms stent thrombosis which include release of the drug everolimus. This 18.7% after cancer (28.5%) in 2010.1 Singapore Health Facts, Ministry of Health.2 Information Paper on Acute Myocardial Infarction in Singapore. September 2011. Health Promotion Board.12 13
  • 8. feature featureBoth are more potent anti- What Can I Do to Make a Difference?platelet agents compared toclopidogrel and proved to be more 1. Time is Muscle!!effective in reducing the risk ofdeath from cardiovascular causes Every minute counts in Acute ST • The diagnosis should be madelike myocardial infarction or elevation myocardial infarction. clear to the ambulance crew andstroke and rates of stent The faster the patient gets advise them to put a call out tothrombosis. However, this better revascularisation, the better his the hospital to activate theoutcome came at a cost of higher outcome and the more myocardium primary angioplasty team. Thisbleeding rates for both drugs. is saved. will help reduce the door to UNBLOCKING balloon time and help the patientPrasugrel increases bleeding risk, This is what you, as a General receive the early intervention forclustering particularly in the Practitioner can do for your patient. his occluded artery.elderly and those with previousstroke or transient ischemic • Once you make a diagnosis in • Aspirin 300 mg should be loadedattack. Therefore, there is anexclusion criteria in its usage.It is contraindicated in those withactive pathological bleeding, definite, clear-cut cases, an urgent call for an ambulance should be made immediately. and Clopidogrel 600 mg if available. YOUR SLEEP Is snoring keeping you or your partner awake at night? You might just be suffering from Obstructivethose going for urgent coronaryartery bypass surgery, above Sleep Apnoea. Find out how this can have more serious consequences than just disrupting your sleep. 2. Better Management of Patients with Chronic75 years old, history of TIA/Stroke D Disease and Aggressive Risk Factor oes your spouse complain that you snore and no amount of time in bed will enable him or her toand cautionary use in those whoweigh less than 60kg. loudly at night? Do you constantly feel sleepy recharge and repair. We should try and adhere to the Sometimes, the usage of more during the day? Do you need to pass urine inTicagrelor significantly decreases guidelines in managing chronic expensive drugs maybe required to the middle of the night? If you’ve said yes to all these What Is Osa?the rates of vascular death, diseases and risk factors. This is bring the levels down within range. questions, you may want to check with a sleep OSA is a potentially serious sleep disorder in whichmyocardial infarction or stroke especially important for secondary We should then try and convince the physician as you could be suffering from Obstructive breathing repeatedly stops and starts during sleep,without the risk of increased prevention as it can make a real patients that they are investing in Sleep Apnoea (OSA), a potentially dangerous sleep with each interruption lasting for 10 seconds or more.overall major bleeding events difference. their health and long-term well-being. disorder that often goes undetected. This can occur during all stages of sleep although it iscompared with clopidogrel. more prevalent in the REM (Rapid Eye Movement)However, there is an increase in According to the World Association of Sleep Medicine, stage of sleep. During sleep, especially during the REMrates of PLATO-defined minor and an estimated 45 per cent of the world’s population stage, the muscles of the upper airway relax,non-CABG major bleeding. There suffer from some form of sleep disorder. Long-term narrowing the airway, and thus obstructs the flow of Dr Jason Lohalso seems to be added advantage Dr Jason Loh is a Consultant in the Cardiology Department of Tan Tock Seng sleep deprivation leads to detrimental effects on oxygen. The brain detects the decrease in oxygenof lower mortality after CABG. Hospital. He graduated from the Medical Faculty of the National University one’s alertness, mood, performance and functioning levels and sends a signal for the upper airway to of Singapore in 1999 and completed his specialist training in cardiology at work. On average, a person requires six to eight reopen, and allow air to flow normally through the air in Tan Tock Seng Hospital in 2009. He was subsequently awarded a HMDPIt is also important to note that with scholarship to Imperial College, London for a one-year fellowship in hours of sleep on a regular basis to maintain a passageway again. This can happen many times duringdouble anti-platelet agent, the Interventional Cardiology and Cardiac Computer Tomography. His main area healthy body and mind. However, those with sleep, resulting in sleep fragmentation and poor of specialty is in Interventional Cardiology, Nuclear Cardiology, Cardiacbleeding risk is doubled compared to Computer Tomography and Cardiac Rehab. disorders such as OSA experience poor quality sleep quality of sleep.single agent alone.14 15
  • 9. feature feature APNOEA-HYPOPNOEA INDEX (AHI)A 2011 report by Channel NewsAsia estimated that a bulky and excessively long soft palate, large tongue There still could be breathing blockages that do notover 15 per cent of the population in Singapore could and large tonsils. Alcohol intake, jet lag and old age AHI SCORE LEVEL show up through snoring,” he cautions.possibly be affected by this condition. Dr Chong Yaw can also cause OSA. 5-15 MildKhian, ENT Consultant, Snoring and Sleep Disorder 15-30 Moderate Dr Chong advises patients who may be in denial aboutCilnic at Tan Tock Seng Hospital (TTSH) thinks this “It’s very easy to tell who an OSA patient is,” says Dr their OSA condition to be aware of the importance offigure could be even higher at around 20 per cent. He Chong. “If you walk past the TTSH Sleep Disorder More than 30 Severe good quality sleep. “Sleep is a transient, reversiblehas been running TTSH’s sleep clinic for the past three Clinic, you’ll see the patients fast asleep in the disengagement from the environment that allows theyears and has observed a steady increase in the waiting room.” endoscopic exam. The patient’s BMI and blood pressure body to repair and regenerate. If you do not restnumber of people coming to him for snoring and sleep reading would also be taken. The gold standard of properly with at least 20 per cent of your sleep being inapnoea problems. “A few years ago, we used to just According to him, this level of fatigue caused by OSA diagnosis, however, is the polysomnography or sleep the REM stage, your well-being will be severelyopen the sleep clinic once a week, but because of the has direct repercussions on one’s relationships, study. For this, the patient will sleep overnight in the affected.”overwhelming demand, we now run two dedicated performance at work and even virility. “Besides being hospital while a technician measures the patient’sSleep Disorder clinics in a week,” he says. On average, extremely irritable and having poor memory and biophysical changes during sleep and determine thethe TTSH Sleep Disorder Clinic sees over 100 people concentration, people with OSA have a 2.5 times more extent of the sleep apnoea.every month, and around 60 per cent of the patients risk of getting high blood pressure, heart rhythm OTHER SLEEP DISORDERSare male. abnormalities, heart disease and stroke. At the same For OSA patients who are obese, weight-loss programmes are necessary so Dr Chong works with a multidisciplinary INSOMNIA time, the health of patients with both OSA and diabetesWho Suffers From It? is put at risk further because OSA is likely to make them team of nutritionists, physiotherapists and surgeons in Difficulty in falling and/or staying asleep.Dr Chong attributes this spike in sleep clinic patients more insulin-resistant.” TTSH to come up with customised programmes for such SLEEPWALKINGto an increasing awareness of sleep disorders as well patients. The first line of treatment recommended for OSA is a non-invasive treatment called CPAP (Continuous Getting up and doing things (not necessarilyas the rise of obesity in Singapore. “People with high This is why it is important to get help if one is sufferingBMI (Body Mass Index) tend to have fat accumulated from the symptoms of OSA. “The interesting thing is Positive Airway Pressure), a kind of respiratory walking) in deep sleep and having noaround the neck, resulting in more blockage in the that most of our patients are brought to our sleep clinic ventilation machine that applies gentle positive pressure recollection of actions after that.upper air passageway,” he explains. However, there by their spouses. Most OSA patients are not aware their on one’s upper airway to relieve the obstruction — through a mask. “The CPAP is very effective but takes NARCOLEPSYare other factors that can contribute to OSA such as breathing is being obstructed when they sleep, or that they are disturbing their sleep partners with their loud some getting used to and some patients get put off with A neurological disorder that causes someone to snoring,” says Dr Chong. the claustrophobic feeling of wearing the mask or the sleep suddenly and involuntarily in the daytime. noise made by the machine,” he adds. Most sleep disorders can be managed with a TTSH SLEEP He adds that he has met patients who came to the sleep clinic thinking they had OSA but it was just a simple case However, in some cases where the patient is unable to combination of effective sleep medication and behavioural modification. However, treatment DISORDER CLINIC of sleep deprivation. “I usually ask about a patient’s sleep patterns. If I see the patient is getting less than six tolerate CPAP due to lifestyle reasons, surgery is offered. There is a spectrum of surgical procedures depends on the root causes of the sleep disorder. The Department of Otorhinolaryngology hours of sleep each day, then the solution is simple — available to help widen the upper airway. One is UPPP This is why sleep clinics are usually staffed with (Ear, Nose and Throat) at TTSH has a sleep just get more sleep. However, OSA is entirely different. (Uvulopapatophayrngoplasty) which shortens and health professionals from multiple disciplines These patients are sleeping a lot but they are not able to stiffens the soft palate thereby increasing the airway (e.g. neurologists, psychiatrists, psychologists, clinic that provides holistic solutions for rest well because of sleep fragmentation.” space behind the palate. Another common procedure is patients with obstructive sleep apnoea problems. respiratory physicians and otolaryngologists) coblation chanelling of the tongue which aims to A multidisciplinary team — including the increase the airway space behind the tongue base. to deal with the wide range of issues that How Is It Diagnosed? ENT surgeon, respiratory physician, dietitians, According to Dr Chong, a visit to TTSH’s sleep disorder Whatever the treatment option, Dr Chong recommends contribute towards sleep disorders. physiotherapists, bariatric surgeons and clinic would typically involve a full patient history- that patients go for a follow-up sleep study after the prosthodontis — is consulted. taking as well as a comprehensive examination of the treatment. “Even if the snoring appears to have Republished with permission from lifewise, upper airway, which includes a flexible fibre optic stopped, it doesn’t mean that OSA has gone away. national healthcare group16 17
  • 10. feature feature “…usually men would satisfy themselves first before thinking of their partner. As a result, there is a lot of unhappiness How to Satisfy between sexes.” Your Partner M en and women in Singapore want to have more and better sex, according to Pfizer’s The Ideal Sex in Asia Survey conducted in 2011. The B2 + T + P study showed that men want an average of 3.5 times B2 refers to both the Brain and Better more sex over a four-week period, while women want quality of life or Blood flow. 1.8 times more sex in the same period. T refers to Time. In another global sexual well-being survey by Durex last GP BUZZ speaks to Associate Professor Chia Sing Joo, year, Singaporeans are ranked second lowest for sexual P refers Passion or Penis.Senior Consultant, Department of Urology of Tan Tock Seng Hospital pleasure satisfaction at 58%, ahead of Japan which B2 (Brain, Better quality of life) + to find how to create the ‘sexual highs’ for a more fulfilling and scored 34%. T (Time) + P (Passion) satisfying relationship. “Satisfaction can be subjective and objective at the same time. It can be a mental, sexual and physical state or even all of the above,” quipped A/Prof Chia Brain – The Most Potent Sex Organ Sing Joo, Senior Consultant, Department of Urology of The human brain can be the most lethal sex organ. Tan Tock Seng Hospital. “In my experiences in sexual It drives the sexual urges of both the male and female counselling, usually men would satisfy themselves first and stimulates sexual reactions, like erection and before thinking of their partner. As a result, there is a ejaculation in man. lot of unhappiness between sexes.” At the same time, the brain aids in the creation of a So, how can man enjoy better sex and satisfy both pleasant sexual process. It begins with knowledge of themselves and their partners? your own organs, their functions, the woman’s anatomy and sex itself. The brain tells you to listen to Four Tips to a Sexier Relationship your partner, to watch her body language and to To improve sexual experience, A/Prof Chia coined a interpret or react to the signs. It helps you stay alert, simple formula to guide males in their sexual be sensitive to her needs, find the erogenous zones encounters with their female counterparts: that stimulates her for a more intimate session.18 19
  • 11. feature feature Better Quality of Life sexually,” explained A/Prof Chia. “Sex with your partner should not be If you cannot recall all the details or Blood Flow – Body “Women need to feel loved and a routine or boring but it is mutual. above, fret not. Fitness men have to earn their trust.” You need to understand that womanGood health and good sex are is not a passive aspect of the sexual A/Prof Chia summarised the goldeninterlinked. With better body Passion or Penis relationship but an active part of the rules to a satisfying sexual in threefitness, sexual performances can – Think Sensually process. They want to be simple points:then be sustained. Good physics A/Prof Chia added that a satisfying appreciated too”. So, do not bealso gives your sex drive an extra sex experience begins even before afraid to ask for feedback and it is actually done. “It is important recognise that this is not personal or Golden Rule #1boost, and helps in the foreplay Fitnessand bodily functions (e.g. erection to nurture a loving environment a report card of your performance. Stay healthy. Exercise regularly andand ejaculation) for a more and relationship with your partner maintain a balanced diet.satisfying experience. So, so that you will desire for each A/Prof Chia shared a tip to end on aremember to exercise regularly other.” positive high, “A simple hug or Golden Rule #2and maintain a balanced and cuddle can do the trick to make the Be Sensitive To Yournutritional diet. Cultivating the Environment woman feel loved.” Partner for Sex Stay alert. Listen, feel and watchOn the other hand, if your lifestyle The environment for sex also Work the Ps your partner. Interpret and react tois not healthy or if you are suffering helps to set the mood right to “You cannot satisfy your partner with her needs.from medical conditions like make sex fun, exciting and even no penis or with penis withoutcardiology issues, your sex life and interesting. For one, come to an erection. Actually size does matter to Golden Rule #3sex drive may be affected. In a agreement with your partner that a lot of woman. She will be unhappy Understand Sex and the Anatomy of You and Yoursurvey conducted in Singapore, it isfound that 52.9% of the 859 male “If you have a normal sized penis domestic and work stresses and issues will not be brought to bed. with a small penis or a very big penis,” said A/Prof Chia. “If you have Partnerrespondents are suffering from (usually four to six inches), with proper Trivial as it sounds, engaging in quick sex and rushing off to nurse a normal sized penis (usually four to six inches), with proper skills, passion Be patient and go slow. Think sensually and develop good skillssome degree of erectiledysfunction*. “Erectile dysfunction skills, passion and physics, you should your hunger pangs can be a major and physics, you should be able to (e.g. engage in foreplay). be able to enjoy a good sex life.”and premature ejaculation are a turn-off. enjoy a good sex life.”few of the common problems inmales that cause the failure to “Couples should avoid having sex on an empty stomach, when you Associate Professor Chia Sing Joosatisfy. Many a times, the men also A/Prof Chia Sing Joo is the Senior Consultant in the Department of Urologylacks the knowledge and skills in are overly full and when you are and Chairman of the Division of Surgery in Tan Tock Seng Hospital. Hesex,” shared A/Prof Chia. Time – Be Patient experience for men and women tired,” advised A/Prof Chia. obtained his medical degree at the National University of Singapore and completed his post-graduate surgical diplomas at the Royal College of and Go Slow are foreplay and emotional Surgeons of Edinburgh, UK. He is also a fellow of the Academy of Medicine,“With good sex knowledge and Some men fail to recognise that connection. Understanding for Improved Singapore (Urology). His sub-specialty includes Uro-Oncology, Sexual Relationship Dysfunction and Sub-fertility.skills, you can still compensate for women are different and generallythe deficiency but do remember to slower to warm up. The survey by “Singaporean men don’t foreplay Appreciate that good sex is mutual A/Prof Chia is also the author of the book, “Ask Prof Chia” – Maleseek professional help or advice Pifzer showed that the two most and as a result, women are often and spontaneous but do not let Urological Problems – The essential guide for Every Man & Couple.early to eliminate these problems.” common factors for an ideal sexual not satisfied both emotionally and your passion go on an overdrive.* J K Tan, D J C Png, L C H Liew, M K Li, M L Wong. Prevalence of Prostatitis-Like Symptoms in Singapore: A Population-Based Study. Singapore Med J 2002 Vol 43(4) : 189-193.20 21
  • 12. feature featureTacklingSports O ver the years, Tan Tock Seng runners and contributing to the Hospital (TTSH) has seen an injury which need to be increase in the number of corrected. patients with sports-related injuriesInjuries which is an irony since most Overpronation (flat footedness), patients visit the clinic with the tightness of the calf muscles may intention of improving their health contribute to plantar fasciitis as Golfers’ Injuries and fitness levels. The growth is can running shoes with insufficient Golf is a typical example in which probably due to increased arch support. The alignment of the the inherently stereotypical participation in sports, the growing knee can sometimes be affected movement and the steep learning range of new sports available in by weakness of the core and hip curve result in repetitive loading of Singapore, as well as a growing muscles while running in turn areas such as the spine, elbows,Early diagnosis and treatment of sports injuries are The end point of awareness of sports medicine as a medical discipline. contributes to anterior knee pain. Medial tibial stress syndrome, shoulder and wrists.important so that patients do not suffer the consequence treating the injury attributed to excessive traction of Counter-intuitively, the forcesof leaving these injuries untreated later in life. With a is not just fitness Though there is a wide array of injuries, there are some common the origin of the tibialis posterior muscle may be related to involved in a golf swing are very high. In golf, axial loading of thestructured set of principles to treat sports injuries and a for daily activity, principles of treating sports excessive eccentric activity of the lumbar spine comes up to eightmultidisciplinary management of these injuries, we can but attaining injuries: muscle in an over-pronating foot. times the body weight versus two times in running, hence explainingbe assured that proper care and management will be a level which Principle 1 From the sports medicine why lower back pain is a commonrendered to achieve an injury-free and fitter body. commensurates Treatment of Sports perspective, a complete diagnosis golf-related injury. Often, poor and management include looking technique, and the overloading of with the demand Injuries Goes Beyond out for these biomechanical the joints and tendons result in for sports, Anatomical Diagnosis problems and correcting them in niggling and recurrent injuries often through Runners Beware! order to prevent recurrence upon return to running. which afflict many golfers. a conditioning We often see runners in the clinic Perhaps the combination of programme for running injuries, which are Principle 2 repetitively loading from poor predominantly a result of overuse or technique is best seen in Figure 1 by an exercise overexertion. Look for the depicting stress fractures of the physiologist and Underlying Technical ribs in a novice golfer learning to Common problems include plantar Error in Sports use his driver. For instance, sports trainer. fasciitis, shin splints and anterior Movement addressing the golf ball with a knee pain (patellofemoral pain hunch often restricts trunk syndrome). While they are often Some of sports are inherently rotation, which results in attributed to over enthusiastic technical in nature and technical compensatory over-rotation of the training, there are also underlying errors are often responsible for shoulder, thus leading to rotator biomechanical issues affecting the overuse injuries. cuff impingement.22 23
  • 13. feature feature Another common error is a lateral centrifugal force). The the set up of the bike. Apparently, Multidisciplinary Management sway of the body towards the target compensation is often to employ the frame of the second hand bike Management of any sports injuries (the correct but counter-intuitive the strength in the arms to was too small resulting in a curled often entails a team made up of movement is to keep the axis of generate more swing speed and up position while riding. The not only doctors, surgeons, rotation still to generate more the additional tightening of the importance of correct equipment physiotherapists, podiatrists and grip often results in tennis or fit cannot be more important. dieticians. golfers elbow. Principle 3 It is important to maintain fitness Hence, complete diagnosis and even during the period of recovery. treatment in a recurrent golf Diagnose the The end point of treating the injury often entails analysis of the Underlying Factors injury is not just fitness for daily golf swing and correcting the Particular to the activity, but attaining a level errors through strengthening and Patient which commensurates to the stretches to improve the range of demand for sports, often through movement as well as drills to help The treatment of sports injuries a conditioning programme by an the body get use to the correct often require a multidisciplinary exercise physiologist and sports movements to facilitate the swing approach. Sports sciences and trainer. (e.g. learning to isolate hip medical disciplines deal with the rotation from upper trunk individual’s condition with an Early Diagnose and Treatment anterior cruciate ligament injuries recognise relevant symptoms (‘good rotation). emphasis on early anatomical Soccer would be the archetypal in their teen or earlier during their pain’ versus ‘bad pain’ in the diagnosis and intensive sport in which the injuries are adulthood. patient’s parlance). Triathlon Pains rehabilitation to prepare one’s predominantly traumatic. While A triathlete chants the mantra fitness for return to sports; there have been evidence-based These injuries can sometimes be Implicit in this model of diagnosis ‘Pain is weakness leaving the beyond that of healing the injured initiatives that are aimed at picked up through musculoskeletal and management of sports injuries body’ as a motivational tool in a structure. There is also an reducing traumatic injuries, it is screening for those playing regularly is the need for a multidisciplinary particularly long bike ride (six emphasis on looking for and just as important to pick up in team sports. Public education team to provide a solution of ‘best hours into it) to combat the lower correcting the root cause in order undiagnosed musculoskeletal also helps as patients can then fit’ for the sportsman.Figure 1 – Stress fractures of the ribs in a novice golfer. back pain. It seemed like a more to prevent recurrence. injuries early and treat these extreme form of the ‘no pain no before they become chronic. gain’ mantra and he had tried Patients are surprised that the Dr Jason Chia various forms of treatment only to end point in treating a sports Often patients who have recurrent Dr Jason Chia is the Head and Consultant of the Sports Medicine & Surgery have the backache hit him every injury is not a painless body but injuries would ignore them so that Clinic of Tan Tock Seng Hsopital. He graduated from the National University of Singapore and obtained his Masters of Sports Medicine from Australia time at the 50km mark, regardless also a body that is moving they can continue with the game. in 2002. He is involved in sports injury management, fitness testing and of the amount of strength or correctly, with the correct If those patients knew what it exercise prescription, weight management, and extracorporeal shockwave strength and flexibility or even therapy as well as gait analysis. He has also written and published a flexibility training. might like in their thirties or handbook for exercise prescription for general practitioners. Dr Chia’s the correct nutritional support to forties when they are plagued by areas of clinical research include ESWT (extracorporeal shockwave Fortunately, the problem was sustain the stress of training and unilateral osteoarthritis, they therapy) as well as biomechanical research. eventually resolved by looking at competing. would have sought treatment for 24 25
  • 14. fitness fitness T he general impression is that you a ‘six-pack’. Losing abdominal core strengthening means fat, which covers up the muscle, is abdominal strengthening. crucial for having a ‘six-pack’! This This is not wrong but it is not needs to be done with aerobic entirely correct. exercise, such as running, swimming or cycling at moderate intensity What is a Core? three to five times per week for at Core means the centre and the least 30 minutes each time and with most important part of our body, diet modification. which is the trunk. We cannot have good arm and leg strength if we There are many types of core don’t have a stable trunk. strengthening exercises — choosing Sculpt Your the correct one to do and Core includes the abdominals, progressing appropriately is important for the exercise to be CORE back, hips and pelvic girdle. All muscles around these areas need effective and to minimise the risk of to be strong and working in injury. Exercises shown on the next harmony in order for us to have a few pages are more advanced and it strong and functional core. can target at multiple core components at one time. A strong core provides a good base for your limb movements during Points to Note During The daily activities such as walking, Exercises climbing a flight of stairs or 1. Draw-in or tighten your lower carrying a heavy load. It also helps abdominal muscle to activate the to improve posture and enhances deeper layer of your core muscle trunk stability so that risk of (called transverse abdominus) to injuries and postural related prevent back injuries. musculoskeletal pain can be reduced. 2. Do not hold your breath, feel any pain or struggle too much to For athletes, a stronger core can maintain the posture. Try the boost performance, no matter easiest set of exercises first and what sport it is. It can enhance move on to the next level if you your kicking strength, swimming or can manage. If you cannot running speed as your core produce maintain the proper form of the stability for your limbs to generate movement in the next level, you the extra power. may not be ready to progress yet. Core Strengthening Exercises 3. Please consult your doctor or Core strengthening exercises such physiotherapist before starting as sit-ups is a good way to these exercises, if you have any strengthen and tone up the back or joint problems, injuries muscle. However, it does not give or other health concerns.26 27
  • 15. fitness fitnessCORE BODY EXERCISESSide Plank Front Plank (2) Moderate: Do the same thing – use your ankle to support instead of your knee. Make sure that your body is in a straight line. (1) Easy: Prop up your elbows in a push-up position. (2) Moderate: Lift up one leg backwards while (3) Challenge: Do the same exercise on the Maintain your trunk and thigh in line by keeping your maintaining the plank. Repeat on the other leg. gym ball. Begin with gym ball against the wall (3) Challenge: buttocks down. Stay in this position for 10 seconds Take note not to arch the lower back. and slowly move it away. Bring your top leg up and and repeat 10 times. (1) Easy: Lie on the side. Lift up your buttock so that body is down for 10 repetitions supported on your elbow and knee. Keep your trunk and hip while maintaining the straight. Perform 10 times with 10-second hold on each side. form. Balance on the ballMermaid (2a) Moderate: Maintaining lower back in neutral position, slowly bring the ball over the head and back. Repeat two sets of 10. (1) Easy: Lie on the gym ball with hands holding a small ball in front. Thigh and trunk should be in a straight line with your knee bending at 90 degrees.(1) Easy: Begin in a kneeling position with (2) Moderate: While maintaining your trunk (3) Challenge: To increase the difficulty, leanyour arm elevated in front at a 90-degree angle. and hip in a straight line, slowly lean backwards backwards to your limit and twist your body to (3) Challenge: In the same position, straighten one until you feel tension over your abdominal and the left at an angle of 45 degrees. Hold for five (2b) After that, bring the ball to the right at leg while keeping buttocks straight. Hold for 10 thigh muscles. Hold for 10 seconds and return seconds and come back to original position. 45 degrees and then to the left. Repeat two seconds and repeat on the other leg. Perform five to original position. Perform 10 repetitions. Repeat five times for each side. sets of 10. times on each leg. 28 29
  • 16. fitness healthy recipes Beef Sirloin withCORE BODY EXERCISES Cranberry SauceBridging Methods: Beef Sirloin: Serving Portion: 1 (1a) Easy: Lie on 1. Season the beef sirloin with salt, pepper, mashed garlic and rosemary. your back with your 2. Heat up the pan, add oil and pan-fry the sirloin until it is medium Ingredients: knee bent. done. Set it aside. Beef Sirloin: (1b) Lift up your Beef Sirloin 120gm buttocks and hold for Asparagus: Mashed Garlic ½ tsp 10 seconds. Perform 1. Heat up the pan and lightly coat the pan with oil, then add in the three sets of 10. Rosemary 1 pinch asparagus and sauté. Salt 1 pinch Cranberry Sauce: Pepper 1 pinch 1. Heat up a small pot and add in the cranberry, bay leaf, rosemary and Oil ½ tsp onion. Season with salt and pepper, and sauté. Asparagus 15gm 2. Mix the chicken gravy mix in water and add into the pan. Let it cook Cranberry Sauce: until gravy thickens. Cranberry (dried) 20gm 3. Strain the gravy. Bay Leaf 1gm Rosemary 5gm Serve the steak and asparagus with the hot cranberry sauce. Onion 5gm Water 100ml Chicken Gravy Mix (Powder) 5gm Nutritional Information Calories (kcal) 278 Saturated fat (g) 3 Salt 1 pinch Carbohydrate (g) 21 Cholesterol (mg) 60 Pepper 1 pinch Protein (g) 26 Dietary fibre (g) 1.4 Total fat (g) 10 Sodium (mg) 366 Kiwi Milk Shake(2a) Moderate: In the same pose, straighten one leg to 45 degrees. Nutritional Information Methods: Ms Janius Tsui Calories (kcal) 173 Serving Portion: 1(2b) Lift up the buttocks using the other leg. Hold for 10 seconds and Ms Janius Tsui is the Senior Physiotherapist Carbohydrate (g) 27 1. Wash and peel each kiwi and cut intoperform two sets of 10 on each leg. in the Physiotherapy Department of Tan Tock Protein (g) 8 Ingredients: four pieces. Seng Hospital. She completed her Masters in Total fat (g) 4 Musculoskeletal and Sport Physiotherapy at Kiwi 170gm 2. Put the kiwi in the blender, then add Saturated fat (g) 1.7Challenge: If the above are too easy, lift up your hands in front and the University of South Australia in 2010. Ms Cholesterol (mg) 6 Low Fat Milk 150ml in the milk and honey.do the same exercise. Tsui works closely with patients suffering from Dietary fibre (g) 2.7 Honey 1 tsp musculoskeletal and sport injuries. She has a 3. Blend until the kiwi is pureed. Sodium (mg) 48 special interest in the shoulder joint and lower 4. Pour into a glass and serve chilled. back. Recipes were designed by the Hospitality & General Services and Nutrition & Dietetics Departments of Tan Tock Seng Hospital. Photo Courtesy of Mr Henry Lim, Photographer, TTSH. 30 31
  • 17. Multi- Disciplinary Specialist Care TTSH PEARL’s suite of clinics and services is guided by the four pillars of care through Evidence Care, Destination Care, Team Care and Personalised Care. We remain committed to delivering a higher level of patient care as we value our patients most.Clinic B1B • Vascular Service Clinic 4B • Veins Service– Orthopaedic Surgery – Diabetes and Endocrine • Thoracic Service– Rheumatology, Allergy and – General Medicine • Plastics, Reconstructive and Aesthetics Immunology – Haematology Services – Infectious Disease – Pain ManagementClinic 2B – Urology – Psychological Medicine Our sub-specialties include: – Renal Medicine– Gastroenterology and Hepatology • General Urology – Respiratory and Critical Care Medicine Our sub-specialties include: • Andrology and Men’s Health • General Gastroenterology • Adrenal Surgery • Hepatology (Liver) Service • Continence and Voiding Dysfunction Clinic B1B • Inflammatory Bowel Disease • Endo-Urology and Stone Surgery Orthopaedic Surgery • Gastrointestinal Endoscopy • Female Urology Tel: (65) 6889 4055 Email: ClinicB1B@ttsh.com.sg • Pancreato-Biliary Diseases • Minimally Invasive Surgery and Rheumatology, Allergy and Immunology • Upper Gastrointestinal Motility Laparoscopic Surgery Tel: (65) 6889 4027 Email: ClinicB1B@ttsh.com.sg • Nutrition • Neuro-Urology • Prostate Surgery Clinic 2B– General Surgery • Reconstructive Urology Tel: (65) 1800-PEARL-00 Email: Clinic2B@ttsh.com.sg Our sub-specialties include: (65) 1800-73275-00 • Robotic Surgery • General Surgery • Subfertility and Sexual Dysfunction Clinic 4B • Colorectal Service • Urologic Cancer Surgery Tel: (65) 1800-PEARL-00 Email: Clinic4B@ttsh.com.sg • Bariatric and Weight Management (65) 1800-73275-00 Services – Endoscopy Services • Upper Gastrointestinal Service • Colonoscopy • Head and Neck Surgical Services • Flexible Cystoscopy • Endocrine Service • Gastroscopy • Liver, Pancreas and Biliary Services